High Prevalence of Goiter in an Iodine Replete Area: Do Thyroid Auto-Antibodies Play a Role?

碘充足的地區的高甲狀腺腫盛行率：甲狀腺自體是否扮演一個角色？

Mahin Hashemipour ； Masoud Amini ； Ashraf Aminorroaya ； Mansour Siavash Dastjerdi ； Hassan Rezvanian ； Ali Kachoei ； Mohammad Hassan Moaddab ； Mohammad Mohammadi ； Roya Kelishadi ； Zhale Amini ； Sassan Haghighi ； Fariba Shojaee-Moradie

《Asia Pacific Journal of Clinical Nutrition》 16卷3期 (2007/09) Pp. 403-410

https://doi.org/10.6133/apjcn.2007.16.3.03

摘要

前言：儘管伊朗長期補充碘，但在某些地區的甲狀腺腫盛行率仍然相當高。這個現象指出除了碘缺乏以外的原因，像是自體免疫疾病也應該被考慮。我們因此評估居住在伊朗內陸地區的孩童抗甲狀腺抗體的盛行率，並將其與這個區域甲狀腺腫盛行率作相關。方法：一個橫斷性研究，從Semiron的108所城市及鄉村的小學（年齡為7－13歲）以多階段隨機集束抽樣選取1948名學生。取得父母所簽署的同意書之後，由內分泌醫師評估孩童的甲狀腺腫等級。比較第二級甲狀腺腫孩童（108名案例）及非甲狀腺腫孩童（111名孩童為控制組）的抗甲狀腺腫抗體。結果：整體來說，1948名學生有36.7%有甲狀腺腫。平均的尿碘量為1.49±0.7 μmol/L。這個值在正常的範圍之內。219名進一步評估的孩童中，4.3%呈現亞臨床低甲狀腺血症，7.3%的抗甲狀腺抗體為陽性。甲狀腺腫與非甲狀腺腫孩童在甲狀腺過氧化酶抗體（anti-TPO）沒有顯著差異（Odds Ratio= 3.2, p= 0.13），而抗Tg則有顯著差異（Odds Ratio: 5.6, 95% CI: 1.18-26.0, p: 0.015）。結論：本研究指出在這個碘缺乏的區域進行碘的補充之後，自體免疫可能是甲狀腺腫仍然持續存在的機制之一，但是其他因子的角色也應該被考慮。

關鍵字

甲狀腺腫 ； 抗甲狀腺抗體 ； 甲狀腺素過氧化酶抗體 ； 甲狀腺球蛋白抗體 ； 自體免疫甲狀腺疾病

並列摘要

Introduction: Despite long standing iodine supplementation in Iran the prevalence of goiter remains high in some areas. This may suggest that causes other than iodine deficiency, such as autoimmune thyroid diseases, should also be considered. We therefore assessed the prevalence of anti-thyroid antibodies in children living in an inland area in Iran and correlated these findings with prevalence of goiter within this region. Methods: In a cross-sectional study, 1948 students were selected by multistage random cluster sampling from the 108 primary schools (age, 7-13 year-old) of the urban and rural areas of Semirom. After obtaining written consent from their parents, the children were examined by endocrinologists for goiter grading. Grade 2 goitrous children (108 cases) were compared with non-goitrous children (111 children as control group) for anti-thyroid antibodies. Results: Overall, 36.7% of 1948 students had goiter. The mean urinary iodine excretion level was 1.49±0.7 μmol/L. This was within normal limits. Of 219 children studied, 4.3% presented with subclinical hypothyroidism, and 7.3% had positive anti-thyroid antibodies. There was non-significant difference of positive thyroperoxidase antibody (anti-TPO) (Odds Ratio= 3.2, p= 0.13) but significant difference of anti Tg between goitrous and non goitrous children (Odds Ratio: 5.6, 95% CI: 1.18-26.0, p: 0.015). Conclusion: This study suggests that autoimmunity may be one of the mechanisms responsible for goiter persistence after iodine replenishment in this iodine deficient region, but the role of other factors should also be considered.

並列關鍵字

goiter ； antithyroid antibody ； thyroidperoxidase antibody ； thyroglobulin antibody ； autoimmune thyroid disease